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PatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

Five doses of the combined diphtheria, tetanus and polio vaccine are enough to provide long-term protection through adulthood, but:

A DTaP booster is currently offered to pregnant women from 20 weeks of gestation (started September 2012). This aims to counter the rise in neonatal whooping cough[7].

Tetanus boosters may be advised if travelling to a high-risk area, or after a high-risk wound if the last booster was more than ten years ago. This is given in the 3-in-one Td/IPV(polio) (tetanus, low-dose diphtheria and polio) vaccine (Revaxis®).

Polio immunisation changed in 2004. The polio vaccine is now combined with DTaP/Hib or Td and given by injection. It used to be given as an oral vaccine in a few drops of vaccine on the tongue.

BCG vaccination against tuberculosis (TB) is given only to those thought to be at high risk of TB. Where required in babies, it is usually given before leaving the hospital soon after birth. Referral is needed, usually to the local chest clinic to arrange vaccination for at-risk individuals after this time.

Background

Active immunity is protection against infectious disease produced by one's own immune system and is usually long-lasting. It is acquired by having the disease itself, or vaccination to it. It involves serum antibodies, cellular response (controlled by T lymphocytes) or a combination (eg, T cells stimulating B cells to produce antibodies). Vaccines aim to provide similar immunity to having had the illness but without the effects and risks of illness.

Passive immunity is the transfer of antibodies from an immune individual. Most commonly this occurs from mother to baby across the placenta. It may also be induced by transfusion of blood or blood products containing immunoglobulin.

Where there is any doubt, rather than withholding vaccine, advice should be sought from an appropriate consultant paediatrician or physician, the immunisation co-ordinator or consultant in health protection.

Contra-indications

A confirmed anaphylactic reaction to a previous dose of a vaccine containing the same antigens; or

A confirmed anaphylactic reaction to another component contained in the relevant vaccine - eg, neomycin, streptomycin or polymyxin B (which may be present in trace amounts in some vaccines).

Note:

Individuals with a confirmed anaphylactic reaction to egg should not receive influenza or yellow fever vaccines.

For the small number of individuals who have a history of confirmed anaphylactic reaction after any egg-containing food, specialist advice should be sought with a view to immunisation under controlled conditions.

Individuals with a confirmed anaphylactic reaction to latex should not receive vaccines supplied in vials or syringes containing latex (eg, caps/stoppers/plungers) although the risk is very small.

Live vaccines

Live vaccines may be temporarily contra-indicated in individuals who are:

Recommendations for giving live vaccines together (or otherwise) were updated in 2015[8]. Live vaccines may be given together or at any time before or after each other, EXCEPT as follows:

Yellow fever and MMR must be given at least four weeks apart and should not be given together.

Varicella and zoster vaccines may be given at the same time as the MMR vaccine but if not given on the same day, there should be ≥4 weeks between them.

Tuberculin skin test (Mantoux test) and MMR: after a Mantoux test, MMR should be delayed until the skin test has been read. If the person has had an MMR, there should be ≥4 weeks before a Mantoux test is done.

Consent is valid provided the individual giving consent has been offered as much information as they reasonably need to make an informed decision, in a form they can understand - eg which vaccination is being given, details of the disease(s) it protects against, side-effects of the vaccination(s) and their management, and the possible consequences if vaccinations are declined.

Consent may be written, verbal or implied (eg, bringing the child to the surgery rather than taking to school) but should be recorded on each occasion.

Consent must be obtained before each injection. When vaccinating children aged under 16, parents should feel involved in the decision, and their concerns should be fully answered.

Adults aged over 18 can give their own consent provided they have capacity (see separate Mental Capacity Act article). Gillick-competent 16- and 17-year-olds may also consent to their own treatment.

In children under 16 years of age, consent should be obtained from an individual with 'parental responsibility'. The natural father of a child, who was not married to the mother at the time of the child's birth, will not automatically have parental responsibility unless the child was born after 1st December 2003, and he is named as the father on the birth certificate.

If the parent appoints another individual (eg, a grandparent) to act in loco parentis, it is the parent's responsibility to inform the surgery about this, by letter or phone. The surgery must record this information in the patient's medical record and should not give the injection without it.

A child aged under 16 may consent or refuse, providing they understand what is involved in the proposed procedure (referred to fully as 'Gillick-competent'). Ideally their parents will be involved. If the health professional giving the immunisation feels a child is not Gillick-competent then the consent of someone with parental responsibility should be sought.

If a person aged 16 or 17 or a Gillick-competent child refuses treatment, that refusal should be accepted. It is unlikely that a person with parental responsibility could overrule such a refusal. It is possible that the court might overrule a young person's refusal if an application to court is made under section 8 of the Children Act 1989 or the inherent jurisdiction of the High Court.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.